Oxygen Saturation Targeting in Premature Infants

Saturday, 7 November 2015

Barbara Smith Weaver, MSN, RN, CCRN
School of Nursing, Western Governors University, Salt Lake City, UT, USA

Infants born prior to thirty-seven weeks gestation are premature and constitute fifteen million infants a year worldwide (Centers for Disease Control, 2012).  Prematurity is the leading cause of infant death in the United States and contributes to a societal burden of 26 billion dollars annually (Institute of Medicine, 2013).  Prematurity is a public health concern.  Nursing maintenance and titration of supplemental oxygen requires meticulous attention to supporting the immature respiratory system.  Nursing must balance oxygen delivery to tissues while minimizing the detrimental effects of oxygen-induced damage to the developing eye, bowel, brain, and lungs.  Emerging evidence suggests that oxygen targeting in infants less than 28 weeks gestation reduces morbidity and mortality prior to discharge from the neonatal intensive care unit.  This project identifies evidence-based practices to target supplemental oxygen and guide clinical and operational decision making in premature infants less than 28 weeks gestation.  Multi-faceted stakeholders include departments who share a vital interest in oxygen administration, quality, safety, cost and the outcomes of premature infants.  Each stakeholder has a unique interest, view, level of power, and influence for the translation of current evidence into practice.  The project facility utilized Dr. Jean Watsons Philosophy and Science of Caring and the IOWA model to provide nursing care to drive institutional changes.  A multidisciplinary team used Kotter and Cohen’s change model to create a shared vision, utilize rapid cycle testing, and lead institutional education and change.  The prevention of the harmful effects of oxygen administration was done by utilizing standardized order sets, clear oxygen targets, education, transparency, visibility, and shared institutional goals.  Closing the gap between research and clinical practice is critical to improve outcomes, decrease unnecessary complications, sustain a culture of change, and sustain satisfaction, quality, and safety.  Exemplary professional practice requires evidence, judgment, and expertise to empower nurses and expand their skills.  Clinical decisions and practices must be based on evidence, clinical expertise, and client values (Institute of Medicine, 2015).  Implementing evidence-based practice is reported to improve nursing satisfaction, increase engagement, and autonomy, and improve client outcomes (Melnyk, Fineout-Overholt, Gallagher-Ford, & Stillwell, 2011).  The Master of Nursing Education program prepares nurses to lead multidisciplinary teams in synthesizing empirical data into evidence-based care across the healthcare institution.  Graduate preparation enables the practitioner to utilize theory, change models, evidence, and clinical reasoning to transform health services and improve client outcomes.  The advanced practice nurse is competent to navigate major barriers to developing a shared vision, motivate colleagues, and improve care delivery.   Research outcomes are intertwined with sound ethical, legal, and professional practice standards to improve nursing services across life continuum and with diverse populations.  The prevention and mitigation of the deliterious effects of supplemental oxygen are crucial to improving outcomes for premature infants.  Oxygen saturation targeting based on empirical data will impact life, death, disease, and disability of the most sensitive, vulnerable, and voiceless of patients.